P-OGC15 Impact of postoperative systemic treatment on survival for oesophageal adenocarcinoma after preoperative chemotherapy and oesophagectomy

Background Perioperative chemotherapy is widely used in the treatment of oesophageal cancer with substantial survival benefit over surgery alone. However, the postoperative part of these regimens is given in less than half of cases, reflecting uncertainty about its benefit. This study estimates the effect of postoperative chemotherapy after surgery for oesophageal cancer using a large population-based dataset and modern statistical methods. Methods Patients with oesophageal adenocarcinoma diagnosed between 2012 and 2018 and underwent preoperative chemotherapy followed by surgery, were identified from a national level audit in England and Wales (National Oesophagogastric Cancer Audit). Postoperative therapy was defined as the receipt of at least one cycle of systemic chemotherapy within 90 days of surgery. The comparative effectiveness of postoperative chemotherapy compared to observation was estimated using inverse propensity treatment weighting (IPTW). Results The study included 2,814 patients, in whom postoperative therapy was given to 1,054 (37.5%). Patients who received postoperative therapy were younger, with a lower ASA grade and were less likely to have surgical complications of any type, including anastomotic leak (all p < 0.001). Tumour characteristics were similar in both groups. Weighted median survival times for patients having no treatment or postoperative chemotherapy were 45.4 months and 57.5 months respectively. There was a life expectancy difference at five years of 2.9 months in favour of postoperative chemotherapy (95%CI 1.1–4.8 months, p < 0.001) with a Hazard Ratio of 0.80 (95%CI 0.70-0.91, p < 0.001). Conclusions Among patients with oesophageal adenocarcinoma treated with preoperative chemotherapy and surgery, improved overall survival was observed in those patients who received postoperative chemotherapy. Minimising surgical complications and improving patient fitness could increase the use of postoperative chemotherapy, leading to better outcomes for patients with oesophageal adenocarcinoma.

Correction of electrolyte balance in surgical patients with urgent surgical interventions

Annotation. Acute appendicitis is one of the most common acute pathologies of the abdominal cavity, which requires immediate surgical intervention and can lead to water-electrolyte imbalance. The aim of the study was to investigate the clinical significance of electrolyte imbalance in patients operated on for acute appendicitis and their correction. We examined 20 urgent surgical patients who were part of the control group and received “traditional” postoperative therapy and 23 patients of the study group who received oral rehydration therapy in the postoperative period to correct water-electrolyte disorders. To analyze the results of the study, profile analysis was used as a modification of multidimensional covariance analysis with repeated measurements. As can be seen from the results of testing the hypothesis of normalization of homeostasis due to the use of oral rehydration therapy schemes, the hypothesis was confirmed with a threshold significance of p=0.0642. The only significant effect of the rate of normalization of potassium concentration in blood plasma is the appointment of oral rehydration therapy with p=0.045. Also, the appointment of oral rehydration therapy is a significant effect of the rate of normalization of sodium and glucose in plasma (normalization of plasma glucose is significantly better in the dynamics of younger patients (p=0.045)). Thus, normalization of potassium and glucose, which correlates with the patient's age, was better in patients receiving oral rehydration mixture in the postoperative period than in patients receiving “traditional” postoperative therapy. Oral rehydration therapy is an acceptable alternative to infusion therapy in patients undergoing surgery for acute appendicitis in the postoperative period.

Study of acute intestinal obstruction management and its outcome

Background: Acute intestinal blockage (AIO) is a common abdominal emergency with a high morbidity and mortality rate. Early blockage diagnosis, skilled operative management, correct technique during surgery and intense postoperative therapy yield superior results. The aim was to study the aetiology, clinical presentation, therapy and outcomes of patients with IO who presented in the emergency department.Methods: This prospective study was conducted at the general surgery department from June 2019 to May 2021. The study comprised 60 patients with IO who presented to the OPD or emergency room and the data was analysed.Results: Among 60 patients with IO, peak incidence was observed in patients above 50 years of age, predominantly among males. Abdominal pain turned out to be the most common symptom of IO in our patients. Patients obstructed in the small intestine were found to be predominant. Post-operative adhesions were the most common cause of IO.Conclusions: Early diagnosis, proper preoperative hydration, fast investigations, and early operational intervention were found to increase survival in patients with intestinal obstruction in the current study.

Korean Medicine Patient Registry of Postoperative Therapy for Musculoskeletal Disorders (KPOP-MD): A study protocol (Preprint)

BACKGROUND The frequency of patients undergoing musculoskeletal surgery has been increasing with the increase in average life expectancy of the population. An aging population with sustained musculoskeletal pain and disability is the main complaint of Korean medical institutions. Recently, Korean medicine clinicians have addressed the collection and analysis of the medical utilization pattern of patients with musculoskeletal discomfort after surgery, to identify the current demographics of patients and to provide empirical evidence for Korean medicine postoperative rehabilitation strategies as well as political decisions on the healthcare coverage of Korean medicine. OBJECTIVE Overall, the aims of Korean Medicine Patient Registry of Postoperative Therapy for Musculoskeletal Disorders (KPOP-MD) are to (1) explore the general characteristics of postoperative patients with musculoskeletal discomfort and (2) evaluate the overall improvement after performing various Korean medicine treatment regimens for musculoskeletal disorders, based on a process involving the collection of nationwide registry outcomes. METHODS KPOP-MD will collaborate with 17 traditional Korean medical institutions and register postoperative patients with musculoskeletal discomfort. A total of 150 patients who meet the eligibility criteria will be registered in the study. After registration, we will collect personal health information from each patient, such as general socio-demographics, surgical site discomfort, anthropometrics, and health-related quality of life (HRQoL) at each assessment. The primary endpoint will be a change in the numeric rating scale for pain at the surgical location. The additional evaluation variables will be a change in the site-specific patient-reported questionnaires, recovery status questionnaires, other discomfort assessments, and cost data. RESULTS not applicable CONCLUSIONS This is the first prospective, multicenter, patient-based registry of postoperative patients with musculoskeletal disorders in various traditional Korean medical institutions. The results of this registry will provide valuable information on the current status of postoperative patients who receive Korean medicine treatments and evidence for reasonable decision-making in the Korean medicine healthcare system in the future. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT03842098.

Lipoma Removal Surgery in White-Rumped Shama (Kittacincla malabarica macraoura)

Lipoma in birds is a benign tumor of adipose cells that often occurs in the subcutaneous area. White-rumped shama, more than three years old, was rushed to the puskesmas with symptoms of decreased activity and singing ability. The results of the examination were two round, multi-focal masses, firmly demarcated, yellowish in color with a soft, chewy consistency measuring ± 4 x 2 x 1 cm on the chest and ± 1 x 1 x 1 cm. in the abdominal area, firmly attached to the subcutaneous layer since six months ago, and getting bigger. The feathers around the mass are shed and vascularized on the surface of the mass. Surgery was performed because the mass suspected of being a tumor growing rapidly and causing pain. It was fasted two hours before surgery and the anesthetic used was a combination of ketamine HCl and xylazine. Postoperative therapy using the antibiotic enrofloxacin, ketoprofen analgesics, 0.9% NaCl fluid therapy and topical antibiotic gentamicin ointment. The tumor that has been successfully removed is yellowish in color with several areas of hyperemia and an oily surface. The results of histopathological examination characterized by the presence of adipose cells that appeared to proliferate well confirmed that the tumor was a lipoma.

The platelet-rich plasma lysate use in the treatment of persistent epithelial defects after keratoplasty

AIM:to evaluate the effectiveness of the platelet-rich plasma lysate (PRP lysate) use in the treatment of persistent epithelial defects (PED) after keratoplasty. MATERIALS AND METHODS:In the study, 60 patients with PED after keratoplasty were included. The 1st group (24 cases)included patients after keratoplasty with low risk of rejection, and the 2nd group 36 cases after keratoplasty with highrisk of rejection. Each group was divided into two subgroupscontrol subgroups 1a (cases 10) and 2a (cases 16), where patients received only standard postoperative therapy, and the main subgroups 1b (cases 14) and 2b (cases 20), in which PRP lysate was prescribed against the background of standard therapy, starting from the Day 15 post-op. As the criterion for effective treatment, complete persistent epithelialization after keratoplasty was considered. RESULTS:The effectiveness of the use of PRP lysate in the subgroup 1b was 85.7%, while complete epithelialization in the control subgroup 1a was recorded in 70%; in the subgroup 2b, complete epithelialization was observed in 55%, in the control subgroup 2ain 43.75%. CONCLUSION:The use of PRP lysate in the treatment of PED after corneal transplantation as an adjuvant therapy is effective and safe in both high and low risk keratoplasty. In the examined category of patients, treatment with blood derivatives increases the frequency and rate of complete epithelialization.

Bladder Stones Removal Surgery Using Cystotomy in a Mix Breed Cat: A Case Report

Urolithiasis is a common disease affecting the urinary tract, including the bladder. This disease characterized by the presence of stones in the urinary tract. Urolithiasis is caused by a build up of mineral crystals. A two-year-old female mixed breed cat with a body weight of 2 kg was brought to the Ontosenovet clinic, Malang City with complaints of anorexia, oligouria, stranguria, and hematuria. The results of physical examination found that the cat was lethargy, 6% dehydrated and at the time of urination the urine was hematuria. The supporting examination is carried out in the form of ultrasound examination (USG). The results of ultrasound examination showed a hyperechoic colored foreign object with an oval shape with smooth edges at the base of the bladder which was suspected to be calculi and resulted in acoustic shadowing at the bottom of the calculi. The cat is diagnosed with urolithiasis with the prognosis of fausta. The procedure is performed is a cystotomy to take calculi in the bladder. Postoperative therapy is marbofloxacin antibiotic injection therapy (SC) 2 mg/kg BW and dexamethasone anti-inflammatory injection therapy (SC) 0.2 ml/cat. Therapy was continued with the administration of the oral antibiotic amoxicillin 25 mg/kg BW, metronidazole antibiotic 15 mg/kg BW, and dexamethasone 0.5 mg/kg BW as an anti-inflammatory. The cat experienced changes after surgery and was given therapy for five days marked by smooth urination without hematuria and no pain at the time of urination.

The Patient’s Perspective: Burn Reconstructive Surgery During the COVID-19 Pandemic

During the Covid-19 pandemic, hospital systems delayed or halted elective surgeries and outpatient care, profoundly disrupting reconstructive burn treatment ranging from surgery to postoperative therapy. This study aims to characterize burn patients’ perspectives on reconstructive surgery during Covid-19. A 12-component questionnaire to burn patients awaiting reconstructive surgery at a single ABA verified Burn Center was administered. Responses regarding willingness to undergo reconstruction, perceived medical and personal impacts of Covid-19, and perspectives on telehealth were gathered. Surveys were administered to patients/caregivers over the phone in English and Spanish. Inclusion criteria consisted of burn patients who had elective reconstructive surgeries delayed or canceled as a result of the pandemic. 51 patients met our inclusion criteria. Of those, 23 patients responded to our survey (45%). Average patient age was 23, 43% were male, and a majority (52%) were pediatric. 22 (96%) patients were willing to undergo reconstruction during the Covid-19 pandemic, despite a perceived increased risk. 43% disagreed or strongly disagreed that telehealth adequately enabled communication with their burn care provider. 78% agreed or strongly agreed that they felt more susceptible to Covid-19 as burn patients. 83% agreed or strongly agreed that the Covid-19 pandemic had created stressors specifically related to their burn care. The majority of patients expressed a strong desire to return to surgical and therapeutic care delayed by Covid-19. Patients reported feeling especially vulnerable to the Covid-19 pandemic as burn patients, and cited difficulty obtaining care and financial stressors as the main causes.